Researchers Develop and Test Six-Question Tool to Screen Adolescents for Substance Abuse in Health Care Settings

From May 2002 through April 2006, researchers at Boston Childrens Hospital tested and developed procedures for implementing a screening tool for adolescent substance abuse in various health settings.

The research team, led by John R. Knight, MD, had refined and validated the six-question tool, called CRAFFT, under a previous grant from the Robert Wood Johnson Foundation (RWJF). See the Program Results Report on ID# 036126.

Key Results

  • The project team:

    • Developed a computer program that delivers the CRAFFT screening and personalized feedback to the patient.
    • Designed a brief office-based intervention for physicians to deliver to adolescent substance users.
    • Screened 2,133 adolescents at seven participating clinics using CRAFFT. There were 222 screenings done via computer; a research assistant screened the remaining 1,911.

Key Findings

  • In an article appearing in the Journal of Adolescent Health, the investigators reported the following finding based on focus groups with primary care providers:

    • The most common barriers to substance abuse screening in primary care practices were "the six T's": Not enough time; lack of training to deal with positive screens; the need to triage competing medical problems; lack of treatment resources; tenacious parents won't leave the room; unfamiliarity with appropriate screening tools.
  • In an article to appear soon in the Archives of Pediatrics & Adolescent Medicine, the investigators report:

    • Of the participants screened with CRAFFT, 14.8 percent were positive.
    • The highest positive rates were at school-based health centers and the rural family practice.
    • Researchers estimated that across the entire sample:
      • 56.5 percent of participants were abstinent.
      • 11.3 percent had problematic use.
      • 7.1 percent met standard criteria for a diagnosis of substance abuse.
      • 3.2 percent met criteria for a diagnosis of substance dependence.
    • Sick visits had a higher positive rate (23.2%) than well care visits (11.1%).
  • Findings from a survey about screening preferences that participants completed independently indicated that more participants (74.9%) reported being "very comfortable" using paper as their screening administration method than screening via a computer or interviews with doctors or nurses.